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Carroll TF, Christie A, Foreman M, Khatri G, Zimmern PE. Macroplastique for women with stress urinary incontinence secondary to intrinsic sphincter deficiency. Int Braz J Urol 2019; 45:989-998. [PMID: 31626522 PMCID: PMC6844350 DOI: 10.1590/s1677-5538.ibju.2019.0070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the subjective and objective outcomes of Macroplastique® (MPQ) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD). Materials and Methods Following Institutional Review Board (IRB) approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection and had 6 months minimum follow-up were reviewed from a prospectively maintained database. Patients were divided into 3 groups: Naïve (Group I), Prior Anti-Incontinence Surgery (Group II), and combined Prior Bulking Agent and Anti-Incontinence Surgery (Group III). Data collected included SUI self-report, Urogenital Distress Inventory (UDI-6) Question 3, and VAS Quality of Life (QoL) Questionnaire scores at baseline and in follow-up. Three-dimensional ultrasound (3DUS) evaluated volume/configuration of MPQ. Success was defined after the last MPQ injection as a UDI-6 Question 3 score of 0 (dry) or 1, and no reoperation for SUI. Results From 2011-2017, 106 of 142 women met study criteria. At a median follow-up of 20 months (mean=26 months; range: 6-71), success rate was 41% for Group I, 40% for Group II, and 65% for Group III (p = 0.22). QoL scores were significantly improved over baseline in all groups. There was no significant difference in clinical outcome between the asymmetrical and symmetrical group on 3DUS. The completely dry rate was highest in Group III at 29%, compared to 4% for Group I and 15% for Group II (p = 0.05). Conclusion Macroplastique® improved subjective and objective outcome measures for SUI secondary to ISD as both a primary and secondary treatment option in women.
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Affiliation(s)
| | - Alana Christie
- University of Texas Southwestern Medical Center, TX, USA
| | | | - Gaurav Khatri
- University of Texas Southwestern Medical Center, TX, USA
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Ozkuvanci U, Donmez MI, Ozgor F, Erbin A, Pasin Ö, Muslumanoglu AY. Durasphere® EXP: a non-biodegradable agent for treatment of primary Vesico-Ureteral reflux in children. Int Braz J Urol 2018. [PMID: 29522294 PMCID: PMC5996799 DOI: 10.1590/s1677-5538.ibju.2017.0514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Durasphere® EXP (DEXP) is a compound of biocompatible and non--biodegradable particles of zirconium oxide covered with pyrolytic carbon. The aim of this study is to evaluate the durability of off-label use of DEXP in the treatment of primary vesicoureteral reflux in children. Materials and Methods: Patients who underwent subureteric injection of DEXP for the correction of primary VUR were retrospectively reviewed. Patients aged >18 years as well as those who had grade-I or -V VUR, anatomic abnormalities (duplicated system, hutch diverticulum), neurogenic bladder or treatment refractory voiding dysfunction were excluded. Radiologic success was defined as the resolution of VUR at the 3rd month control. Success was radiographically evaluated at the end of the first year. Results: Thirty-eight patients (9 boys, 29 girls; mean age, 6.3±2.7 years) formed the study cohort. Forty-six renal units received DEXP (grade II: 22; grade III: 18; grade IV: 6). Mean volume per ureteric orifice to obtain the mound was 0.70±0.16mL. First con- trol VCUG was done after 3 months in all patients. After the first VCUG, 6 patients had VUR recurrence. Short-term radiologic success of DEXP was 84.2%. Rate of radiologic success at the end of the first year was 69.4% (25/32). Lower age (p:0.006) and lower amount of injected material (p:0.05) were associated with higher success rates at the end of 1 year. Conclusion: This is the first study to assess the outcomes of DEXP for treatment of primary VUR in children. After 1 year of follow-up, DEXP had a 69.4% success rate.
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Affiliation(s)
- Unsal Ozkuvanci
- Department of Urology Haseki Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Muhammet Irfan Donmez
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Faruk Ozgor
- Department of Urology Haseki Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology Haseki Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Özge Pasin
- Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
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Durability of Collagen Injection for Stress Urinary Incontinence in Women Proven by Transvaginal 3-Dimensional Ultrasound. Female Pelvic Med Reconstr Surg 2015; 21:25-9. [DOI: 10.1097/spv.0000000000000094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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ACR Appropriateness Criteria pelvic floor dysfunction. J Am Coll Radiol 2014; 12:134-42. [PMID: 25652300 DOI: 10.1016/j.jacr.2014.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 01/23/2023]
Abstract
Pelvic floor dysfunction is a common and potentially complex condition. Imaging can complement physical examination by revealing clinically occult abnormalities and clarifying the nature of the pelvic floor defects present. Imaging can add value in preoperative management for patients with a complex clinical presentation, and in postoperative management of patients suspected to have recurrent pelvic floor dysfunction or a surgical complication. Imaging findings are only clinically relevant if the patient is symptomatic. Several imaging modalities have a potential role in evaluating patients; the choice of modality depends on the patient's symptoms, the clinical information desired, and the usefulness of the test. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions; they are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Hegde A, Smith AL, Aguilar VC, Davila GW. Three-dimensional endovaginal ultrasound examination following injection of Macroplastique for stress urinary incontinence: outcomes based on location and periurethral distribution of the bulking agent. Int Urogynecol J 2012; 24:1151-9. [DOI: 10.1007/s00192-012-1983-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/20/2012] [Indexed: 10/27/2022]
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Delayed presentation of pseudoabscess secondary to injection of pyrolytic carbon-coated beads bulking agent. Female Pelvic Med Reconstr Surg 2012; 18:303-5. [PMID: 22983276 DOI: 10.1097/spv.0b013e318264c8e0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Periurethral masses after injection of Durasphere bulking material have been previously reported to occur within 12 to 18 months of administration of the agent. METHODS We present a case report of an anterior vaginal wall mass resulting from a pseudoabscess containing Durasphere agent 5 years after injection. A literature review of urethral bulking agent complications and imaging is also provided. RESULTS The patient's anterior vaginal wall mass was thought to be due to a pseudoabscess secondary to injection of bulking agent. Pelvic imaging was helpful both in identifying the mass and in surgical planning. The patient was successfully treated by outpatient transvaginal resection of the material. CONCLUSIONS Urethral bulking agents, although generally safe and effective in the treatment of stress urinary incontinence, can lead to formation of pseudoabscesses. Although these are usually recognized within the first 18 months after injection, they may not be identified until several years later.
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Crites MA, Ghoniem GM. Bladder mass “collagenoma”. Int Urogynecol J 2010; 22:621-3. [DOI: 10.1007/s00192-010-1310-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 10/16/2010] [Indexed: 11/28/2022]
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Furness JB, Shafton AD, Hirst GDS, O'Connell HE. Stimulated smooth muscle neosphincter in male intrinsic sphincter deficiency: Proof of principle studies in a rabbit model. Neurourol Urodyn 2010; 29 Suppl 1:S24-8. [DOI: 10.1002/nau.20835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Stress urinary incontinence is a common health problem affecting women and interfering with their quality of life. The use of bulking agents for urethral augmentation seems to be a beneficial way of restoring continence in these patients while avoiding the risk of surgical intervention. Many agents are available for injection, but the ideal choice should be durable, nonmigratory, and hypoallergenic, while evoking healing with minimal scarring. We reviewed the literature to provide an update on the best techniques of bulking agent injection, to describe the different available injectable agents, and to give their outcome and possible complications.
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Affiliation(s)
- Ahmed F Kotb
- Department of Urology, Jewish General Hospital, 3755 Côte Sainte-Catherine, Montreal, Quebec QC H3E 1T2, Canada
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Isom-Batz G, Zimmern PE. Collagen Injection for Female Urinary Incontinence After Urethral or Periurethral Surgery. J Urol 2009; 181:701-4. [DOI: 10.1016/j.juro.2008.10.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Ginger Isom-Batz
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Philippe E. Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Sokol ER, Aguilar VC, Sung VW, Myers DL. Combined trans- and periurethral injections of bulking agents for the treatment of intrinsic sphincter deficiency. Int Urogynecol J 2007; 19:643-7. [PMID: 17965815 DOI: 10.1007/s00192-007-0493-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 10/11/2007] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to compare Contigen combined with Durasphere to Contigen injections alone for the treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD). Subjective and objective incontinence outcomes were compared at 2 weeks and 6 months. We compared rates of urinary retention and future incontinence surgery between groups. Thirty-three women underwent combined injections, and 51 underwent Contigen injections. Two weeks postoperatively, more women in the combined group were cured (72.7 vs. 39.2%, P = 0.003), but this difference diminished at 6 months (33.3 vs. 29.4%, P = 0.70). Retention was more common in the combined group (P = 0.002, odds ratio [OR] = 0.062 [95% confidence interval (CI) = 0.007, 0.52]). Twenty-three women in the Contigen and ten in the combined group underwent subsequent incontinence surgery (P = 0.17, OR = 2.03 [95% CI = 0.80, 5.1]). Combining Contigen and Durasphere injections to treat SUI with ISD does not improve outcomes compared to Contigen injections alone.
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Affiliation(s)
- Eric R Sokol
- Urogynecology and Reconstructive Pelvic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room HH333, Stanford, CA 94305, USA.
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Comparison of the precision of transurethral endoscopic versus ultrasound-guided application of injectables. BJU Int 2007; 101:245-9. [PMID: 17922861 DOI: 10.1111/j.1464-410x.2007.07262.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the precision of transurethral endoscopic- vs ultrasound (US)-guided injections, as transurethral application of various injectables under endoscopic view are widely used to treat urinary incontinence. MATERIAL AND METHODS Bovine collagen was injected into the lower urinary tract in 20 dead female pigs. In each pig five depots of collagen were injected and there were five pigs in each group. In group I collagen was injected into the urethral wall under endoscopic control. In group II collagen depots were injected periurethrally under endosocopic guidance. In group III collagen was injected into the urethral wall under US control. In group IV collagen depots were injected periurethrally under US guidance. A transurethral US probe (6 F, 15 MHz) and injection device were used for transurethral US-guided injections. In all pigs the urethra and the periurethral tissue were removed after injection and investigated using anatomical preparations and histological sections. RESULTS In group I only two collagen depots were actually located in the urethral wall in two pigs (two of 25 depots, 8%). In group II five depots in two pigs were located in the urethral wall (five of 25 depots, 20%). The periurethral collagen depots were found to spread out in the loose connective and fat tissue around the urethra. In group III all US-guided injections of collagen were situated in the urethral wall and in group IV they were all located periurethrally. CONCLUSIONS The present study shows that endoscopic application of injectables is an inaccurate technique, while US-guided injections are precise. US-guided injection enables excellent control of the therapeutic procedure.
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Valsky DV, Yagel S. Three-dimensional transperineal ultrasonography of the pelvic floor: improving visualization for new clinical applications and better functional assessment. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1373-87. [PMID: 17901141 DOI: 10.7863/jum.2007.26.10.1373] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE With increasing awareness of the scope of pelvic floor disorders has come development and introduction into clinical practice of new imaging techniques, with increasing importance of ultrasonography. Complex pelvic floor anatomy, the conceptual difficulty in the basics of some pelvic floor disorders, and the uneven standardization of ultrasonographic techniques were the impetuses of this review. The purpose of this study was to review the basic anatomy of the pelvic floor and the transperineal ultrasonographic evaluation technique and to provide an overview of the current clinical use of 3-dimensional transperineal ultrasonography in the evaluation of the anterior and posterior pelvic floor compartments. METHODS A literature review illustrated with index cases from our center was conducted. RESULTS Ultrasonography has been widely applied to evaluation of the anterior and posterior compartments of the pelvic floor. Three-dimensional ultrasonography has a role in improving pelvic floor assessment. CONCLUSIONS Three-dimensional transperineal ultrasonography has been applied to evaluation of normal and pathologic pelvic floor anatomy. Practical application, through well-designed and sufficiently powered clinical studies, will establish the association between the clinical presentations of dysfunction with ultrasonographic findings.
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Affiliation(s)
- Dan V Valsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, PO Box 24035, Mt Scopus, 91240 Jerusalem, Israel
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Chapple CR, Brubaker L, Haab F, van Kerrebroeck P, Robinson D. Patient-perceived outcomes in the treatment of stress urinary incontinence: focus on urethral injection therapy. Int Urogynecol J 2006; 18:199-205. [PMID: 16847584 DOI: 10.1007/s00192-006-0148-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 05/08/2006] [Indexed: 10/24/2022]
Abstract
Intervention for stress urinary incontinence (SUI) is generally focused on minimizing urinary leakage. However, the overall impact of SUI therapy on patients' quality of life is, arguably, more important than leakage outcomes. We performed a literature search to investigate the effect of urethral injection therapy on quality of life. Significant quality-of-life improvements have been observed with a number of injectable agents, while there is a distinct lack of correlation between subjective and objective outcomes. Two studies comparing urethral injection therapy with surgical intervention found superior objective efficacy with surgery, but no significant differences in quality-of-life improvements. Personal goals of patients undergoing urethral injection are yet to be explored, but there may be willingness to trade a lower success rate in favor of a more minor treatment procedure. In conclusion, quality-of-life improvements after urethral injection appear significant and comparable to those obtained with surgery. Further study of patients' own perceptions, pre- and posttreatment, would be valuable.
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Affiliation(s)
- Christopher R Chapple
- Urology Research Department, J Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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Abstract
PURPOSE OF REVIEW To highlight the current role of the imaging techniques in urinary incontinence. RECENT FINDINGS The text for the Third International Consultation of Incontinence, published in 2005, provides major insights into all the imaging techniques. In addition, the most important findings regarded imaging technique in the patients surgically treated for stress urinary incontinence. An article from Singapore suggested that about one-third of patients with tension-free vaginal tape had the tape in the proximal or distal one-third of the urethra, without jeopardizing tape's clinical efficacy. This finding would tend to indicate that the support of the midurethra, as suggested by the integral theory of incontinence, might not be mandatory. Another interesting article demonstrated by ultrasonography, a surprisingly high rate of collagen retention in patients who had undergone collagen injection for stress urinary incontinence due to intrinsic sphincter deficiency. SUMMARY Most of the articles published underscored the role of ultrasonography and/or magnetic resonance imaging in assessing the patients with urinary incontinence. The purpose of the imaging is to investigate the correlations between morphology and function of both the bladder and the urethra, and detect concomitant defects in the pelvic floor. Definitive studies comparing the different diagnostic options, as well as their impact on patient management and outcome are still lacking.
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Affiliation(s)
- Giacomo Novara
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy
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Bibliography. Current world literature. Female urology. Curr Opin Urol 2006; 16:310-3. [PMID: 16770134 DOI: 10.1097/01.mou.0000232056.97213.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Poon CI, Zimmern PE. Is there a role for periurethral collagen injection in the management of urodynamically proven mixed urinary incontinence? Urology 2006; 67:725-9; discussion 729-30. [PMID: 16618559 DOI: 10.1016/j.urology.2005.10.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 09/26/2005] [Accepted: 10/19/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the effectiveness of periurethral collagen injection (PCI) in patients presenting with symptoms of mixed urinary incontinence (MUI) and urodynamically demonstrated sphincter deficiency and detrusor overactivity. METHODS A retrospective review was performed on all patients undergoing PCI from February 1999 to February 2003, during which those with MUI were treated with PCI as first-line therapy. The inclusion criteria were MUI symptoms, detrusor overactivity on urodynamic study, stress urinary incontinence due to sphincter deficiency (determined from physical examination, stress test, urodynamic study with Valsalva leak point pressure, and cystography findings, without urethral hypermobility). The primary outcome measures were the Urogenital Distress Inventory (UDI), Incontinence Impact Questionnaire, and quality-of-life score and the need for anticholinergic medications or additional surgery. Comparisons were performed using the Wilcoxon signed ranks test and paired t test. RESULTS Of the 56 patients who underwent PCI, 43 presented with symptoms of MUI, and 16 of these (29%) had both detrusor overactivity and stress urinary incontinence on urodynamic study. The mean follow-up after PCI (without additional PCI) was 18 months (range 6 to 39). The mean age was 65 years (range 40 to 84). The mean Valsalva leak point pressure was 54 +/- 40 cm H2O (range 18 to 146). Ten patients had undergone previous anti-incontinence procedures, and anticholinergic medications had failed in six. The questionnaire scores, indicating severe MUI/poor quality of life before PCI, improved after PCI: UDI question 1, 2.3 +/- 0.8 versus 1.3 +/- 1.0 (P = 0.021); UDI question 2, 2.1 +/- 1.2 versus 1.4 +/- 1.0 (P = 0.068); UDI question 3, 2.9 +/- 0.4 versus 1.8 +/- 1.2 (P = 0.010); and quality-of-life question, 8.6 +/- 2.1 versus 5.2 +/- 3.5 (P = 0.026). The mean injected volume/patient was 8.5 cm3 (range 5 to 17) within a mean of 1.9 treatments (range 1 to 3). Four patients continued taking anticholinergic medications and one proceeded to sling placement. CONCLUSIONS The use of PCI as the primary/initial intervention in patients with MUI may be the preferred approach, particularly in patients with an elevated risk of anticholinergic medication side effects or when voiding dynamics preclude sling placement.
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Affiliation(s)
- Christina I Poon
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA
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Bibliography. Current world literature. Minimally invasive surgery in urology. Curr Opin Urol 2006; 16:112-7. [PMID: 16479214 DOI: 10.1097/01.mou.0000193398.85092.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000172405.15632.cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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